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DefinitionsEven among experts, terms such as database and network are not usedin the same manner. For this report, the committee advances thefollowing working definitions for certain major concepts, buildingto its view of an HDO.

DatabaseThe term database embraces many different concepts: from paperrecords maintained by a single practitioner to the vastcomputerized collections of insurance claims for Medicarebeneficiaries; from files of computerized patient encounter formsmaintained by health plans to discharge abstract databases of allhospitals in a given state; from cancer and trauma registriesmaintained by health institutions and researchers to major nationalhealth survey data of federal agencies. As commonly used and meantin this report, a database (or, sometimes, data bank, data set, ordata file) is ”a large collection of data in a computer, organizedso that it can be expanded, updated, and retrieved rapidly forvarious uses” (Webster’s New World Dictionary, 2nd ed.).

Although databases may eventually be linked (or linkable) toprimary medical records held by health care practitioners, thisreport addresses databases composed of secondary records.2Secondary files are generated from primary records or are separatefrom any patient encounter (as in the case of eligibility orenrollment files for health plans and public programs). They arenot under the control of a practitioner or anyone designated by thepractitioner, nor are they under the management of any healthinstitution (e.g., the medical records department of a hospital).Furthermore, they are not intended to be the major source ofinformation about specific patients for the treating physician.Secondary databases facilitate reuse of data that have beengathered for another purpose (e.g., patient care, billing, orresearch) but that, in new applications, may generate newknowledge.

Key Attributes of DatabasesIn reviewing the considerable variation in databases that might beaccessed, controlled, or acquired by HDOs, the committee sought asimple way to characterize them by key attributes. It decided ontwo critical dimensions of databases: comprehensiveness andinclusiveness. (Because these terms are used with distinct meaningsin this report, they are italicized whenever used.)

Comprehensiveness. Comprehensiveness describes the completenessof records of patient care events and information relevant to anindividual patient (Table 2-1).4 It refers to the amount ofinformation one has on an individual both for each patientencounter with the health care system and for all of a patient’sencounters over time (USDHHS, 1991, refers to this ascompleteness). A record that is comprehensive contains: demographicdata, administrative data, health risks and health status, patientmedical history, current management of health conditions, andoutcomes data. Each category is described briefly below.

Demographic data consist of facts such as age (or date ofbirth), gender, race and ethnic origin, marital status, address ofresidence, names of and other information about immediate familymembers, and emergency information. Information about employmentstatus (and employer), schooling and education, and some indicatorof socioeconomic class might also appear.Administrative data include facts about health insurance such aseligibility and membership, dual coverage (when relevant), andrequired copayments and deductibles for a given benefit package.With respect to services provided (e.g., diagnostic tests oroutpatient procedures), such data also typically include chargesand perhaps amounts paid. Administrative data commonly identifyproviders with a unique identifier and possibly give additionalprovider-specific facts; the latter might include kind ofpractitioner (physician, podiatrist, psychologist), physicianspecialty, and nature of institution (general or specialtyhospital, physician office or clinic, home care agency, nursinghome, and so forth).Health risks and health status Health risk information reflectsbehavior and lifestyle (e.g., whether an individual uses tobaccoproducts or engages regularly in strenuous exercise) and factsabout family history and genetic factors (e.g., whether anindividual has first-degree family members with a specific type ofcancer or a propensity for musculoskeletal disease).4  

The discussion of comprehensiveness and inclusiveness ofdatabases is couched in terms of what might be regarded as thetraditional domain of medical care, including mental health care.Clearly, more advanced databases could include information ondental care and care provided by health professionals that practiceindependently, such as nurse-practitioners and nurse-midwives,acupuncturists, or alternative healers of various sorts. Even morefar-reaching databases might contain information on sociomedicalservices provided through, for instance, day care and home care foradults or childrens